From fiery crash to medical miracle: New Jersey man is world’s first to receive successful face and double-hand transplant
Joseph DiMeo was driving home from work in August 2018 after pulling a night shift, when he fell asleep behind the wheel. A stranger dragged him from the flaming wreckage.
More than two months later when DiMeo, then 20, woke up from an induced coma, his first thought was of his Dodge Challenger SRT, which he had paid for himself and customized with a new exhaust system and wheels.
The car had been totaled. DiMeo was burned over 80% of his body.
After 20 surgeries, his hands were still barely usable, with his fingers reduced to mere nubs. His face was a constant reminder of that awful day.
So DiMeo, of northern New Jersey, went through extensive testing and preparation in hopes of getting a new face and hands from a donor.
Now, 22 and almost sixmonths out from his surgery, his transplant team is ready to declare DiMeo’s procedure a success. He is the first person in the world to receive a face and two hands.
“He was always calm and collected – never lost hope,” transplant team leader, Dr. Eduardo Rodriguez, chair of the Hansjörg Wyss Department of Plastic Surgery at NYU Langone, said of DiMeo.
“He always felt he was not going to be this way for the rest of his life,” Rodriguez added. “He is a large part of our success.”
DiMeo, of Clark, New Jersey, about 20 minutes from Newark, said he hopes that going public with his story will help others.
“I just felt like everyone needs to know about this,” said DiMeo, who appeared at a news conference Wednesday at NYU Langone. “I hope that my motivation inspires other people to get back on their feet and not look down in the dumps …You’ve got to work hard to change things and you can’t give up.”
A year of preparation
There have been more than 40 face transplants worldwide since 2005 and more than 85 single or double arm transplants.
Twice before, surgeons have tried to give a patient a new face and two hands. A 30-year-old man in France died two months after the attempt from an infection likely related to his underlying burns. A patient in Boston had to have his hand transplants removed because they didn’t take.
The success with DiMeo proves it’s possible, and that marks a substantial change in the field, said Dr. Scott Hansen, chief of hand and microvascular surgery at the University of California, San Francisco.
“This pushes the envelope of everything we’ve done as a specialty,” he said. “This is groundbreaking and earth shattering.”
Rodriguez, who had performed three previous face transplants, felt that DiMeo would make an excellent candidate for the procedure.
He was young, stable and healthy and would likely heal quickly. His accident was only about a year earlier, so his brain was likely to remember quickly what it was like to have a functioning face and hands. And he was determined.
DiMeo showed up on time to every appointment and followed his doctors’ instructions to the letter.
But Rodriguez worried it would be extremely difficult to find a match for the transplant.
After the accident, DiMeo lost and received lots of blood. The body reacts to that foreign blood by activating the immune system and making antibodies.
These antibodies meant only about 6% of people on the planet would have the right immune profile to prevent DiMeo’s body from rejecting a transplant outright.
And an antibody match wasn’t enough. The donor also would have to have similar skin color to DiMeo’s – a substantial difference would look strange – without any identifying scars or tissue trauma.
It made sense to get both the face and arms from the same donor, Rodriguez said, because of the difficulty of matching DiMeo’s antibodies and the increased risk of rejection with multiple donors.
Doctor and patient settled in for what they expected would be a long wait.
Meanwhile, both kept busy.
DiMeo needed a lot of tests. “It got a little annoying,” he admitted.
There were checks to assess the state of his nerves after the burns. Tests of his tendons, his eyes and his teeth to make sure they were in good shape. X-rays of his lungs.
“My body was fine, it was just the skin that was damaged,” DiMeo said.
He also didn’t suffer any pain once he left the hospital, though his skin was super itchy.
Rodriguez and a huge team of colleagues at NYU Langone spent nearly a year mapping out and practicing the surgery they hoped to perform on DiMeo.
They outlined the operation in a simulation lab. They rehearsed on donated cadavers. Despite the COVID-19 pandemic, they performed nearly a dozen run-throughs with operating room staff. They developed a checklist to follow during the surgery, and ironed out every step, shaving off time where they could to minimize DiMeo’s risk.
“When the operation comes, it’s almost second nature to us,” Rodriguez said.
“We know that we don’t want to let a donor go to waste,” he continued. “Also, the patient who’s risking their life, the recipient, we would not want to see that person have a severe complication or potentially die because of a poorly executed operation.”
Moments of truth
With a solid organ like the kidney, the patient is likely to die if too much time passes, so doctors make compromises on immune compatibility to make sure the patient survives.
With a face and arm transplant, Rodriguez said, “we had the luxury of waiting,” for the ideal match.
But they didn’t have to wait as long as they expected.
On Aug. 9, just 10 months after the extensive national search began, Rodriguez got a phone call about a potential donor in Delaware.
He traveled there the next day to evaluate the donor himself.
Amazingly, the donor was a match for DiMeo’s antibodies and skin tone. He was transported to NYU Langone that night.
DiMeo arrived the same evening and a CAT scan was taken of his face and arms. The data was immediately sent to Michigan, where a specialized printer called Materialise began making a 3D cutting guide for the surgery.
It was completed the next day and shipped to New York.
Early on Aug. 12, cutting guide in place, the 80-person surgical team prepared to do what it had practiced for so long.
“Everything went like clockwork,” Rodriguez said.
The only unrehearsed moment: after the team had stitched on both hands and DiMeo’s new face, his left hand started to change color. The team realized that there was a small blood clot, which they quickly resolved.
The surgery lasted 23 hours.
That sounds long, but thanks to the months of practice and the cutting guide, it was shorter than Rodriguez’ three previous face transplants, which didn’t include hands.
“It is highly intense all the way through,” he said, noting he took three quick breaks to go to the bathroom and grab a coffee and snack. “You blink and it’s over.”
An incredible gift
Although a face and hand transplant technically isn’t lifesaving, the way replacing a damaged kidney or lung can be, a successful surgery is transformative.
Rodriguez said all four of the patients he’s transplanted end up looking like a hybrid of themselves and their donor.
People who receive face transplants don’t have identity crises, Rodriguez said. It’s much harder for them to adjust to an injured face than a new one, he said. In MRI scans, people have trouble recognizing their injured selves, but they immediately see themselves after a transplant.
DiMeo received the donor’s entire face, from his hairline at the top of his forehead to the bottom of his neck and ear to ear.
Rodriguez took some of the underlying bone structure of the donor’s face, so it wouldn’t droop after transplantation. He included muscles that work the cheeks so the pulley system that allows movement in the corners of the mouth would function.
DiMeo received both arms from the mid-forearm down, including all the bones in the forearm, wrist and fingers, 21 tendons, 2 arteries, 4 veins, 3 major nerves. It’s a lot of pieces to connect.
“The level of complexity here is mind bending,” said UCSF’s Hansen, also chief of plastic surgery at Zuckerberg San Francisco General Hospital and Trauma Center and team doctor for the San Francisco Giants.
Some argue that arm transplants aren’t worth the multi-million-dollar expense; prosthetics are cheaper and nearly as good. Hansen disagrees.
“Clearly, the function of the transplanted hands are way superior to his burned hands,” he said of DiMeo. “The sensation will be a lot better. That’ll be a huge help for him.”
His facial improvements are “undeniable,” Hansen said.
Before the transplant, DiMeo had no eyelids, which eventually would have led to blindness. Giving him functional lips will improve his speech and enable him to enjoy solid foods. A new face also allows him to smile and show emotion, “which is life-changing,” Hansen said.
DiMeo receives immune suppressive medication to keep his body from rejecting the new parts. Blood tests can tell if his antibody levels to the donation start to rise, and his medication can be quickly adjusted to prevent rejection.
He wrote a letter to his donor’s family thanking them, but they haven’t wanted to be identified so far, so he hasn’t had any direct contact.
Nothing is publicly known about the donor other than that he died of a stroke – and he was DiMeo’s perfect match.
To ease the bereaved family’s trauma, NYU LaGuardia Studio took detailed photos before the donation. During the surgery, they made 3D-printed replicas of the donor’s face and arms. When they returned the donor to his family, he looked as he had before the transplant.
“It is the highest fidelity,” Rodriguez said, and important for the family. “We want to be able to maintain the integrity of that donor for any end-of life rituals.”
After the transplant, DiMeo was in the hospital for more than six weeks and then in inpatient rehab.
That’s where the hard work begins, Rodriguez said, “to get those hands back to normal function.”
The face recovers largely on its own, he said, but the hands take months of work to relearn how to get out of a chair, feed yourself, get dressed, bathe.
DiMeo, who still has three hours of therapy three times a week, has achieved all those milestones already.
He can hold a piece of pizza and a hamburger again, though he still prefers Italian food. He can swipe on his smartphone, lift weights, play pool, and do push-ups from a bench. He can walk his beloved Boston terrier, Buster, who knew him right away, even in rehab.
Sensation is slowly returning, and he can tell now when his hands are cold.
DiMeo has only two remaining goals: “To drive again and get back to work.”
He’s confident he will know what to do behind a steering wheel, though his doctors want him to try with a simulator first.
And he still dreams of becoming a union dock worker.
That doesn’t seem unreasonable for a young man who already is a year ahead of where his physical therapists expected him to be by now.
“I have a lot of motivation,” DiMeo said. “I can’t give up. I’ve got a second chance. I can’t mess that up.”
Contact Karen Weintraub at firstname.lastname@example.org.
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